Provider Demographics
NPI:1902971260
Name:HUCK, JEAN (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:
Last Name:HUCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 WHEATSHEAF LN
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3615
Mailing Address - Country:US
Mailing Address - Phone:215-331-0515
Mailing Address - Fax:215-331-8144
Practice Address - Street 1:2701 HOLME AVE STE 203
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-331-0515
Practice Address - Fax:215-331-8144
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005082C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058774NKFMedicare ID - Type Unspecified